title: Interval of less than 5 years between the first and second operation is a risk factor for a third operation for Crohn's disease.
abstract: BACKGROUND
  Previous studies have shown various risk factors for the initial and/or the second operation for Crohn's disease (CD). However, limited data are available with regard to the risk factors for a third operation. We aimed to clarify the risk factors for a third operation for CD.
  
  
  METHODS
  A total of 200 CD patients who underwent a second intestinal surgery at 13 institutions were examined. We performed univariate and multivariate analyses to examine the influence of independent variables on the cumulative rate of needing a third operation.
  
  
  RESULTS
  A total of 95 patients underwent a third operation. The overall 5-year and 10-year cumulative rates for the third operation were 42.2% and 71.0%, respectively. In univariate analysis, the interval between the initial and the second operation (P = 0.0069), postoperative administration of infliximab (P = 0.0030), and the anatomical site of the disease (P = 0.0132) were significant risk factors for the third operation. In multivariate analysis, the interval between the initial and the second operation (P = 0.0287) and postoperative administration of infliximab (P = 0.0297) remained significant risk factors for the third operation. The cumulative 5-year third operation rate was significantly higher in patients with an interval of less than 5 years between the first and second operations than for those with an interval of 5 years or more (47.8% versus 35.2%, P = 0.0232).
  
  
  CONCLUSIONS
  An interval of less than 5 years between the first and the second operations is a significant risk factor for a third operation in patients with CD.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. toshwatanabe@yahoo.co.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Iwao
authors.initials: I
authors.lastname: Sasaki
authors.forename: Akira
authors.initials: A
authors.lastname: Sugita
authors.forename: Kohei
authors.initials: K
authors.lastname: Fukushima
authors.forename: Kitaro
authors.initials: K
authors.lastname: Futami
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003424:Crohn Disease / Q000401:mortality* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult